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Health Care Reform

As federal health care reform law is implemented and assessed, states are exploring various reforms in health care coverage, quality of care, and methods of delivery and payment. Given the many interests involved, and the myriad applicable laws and regulations that apply, creating new models of health care delivery is daunting at best.

Our experts can help state policymakers throughout the cycle of health care policy reform. For example, we were integrally involved in development, drafting, and implementation of Massachusetts’ 2006 and 2012 landmark health care reforms, which embody many of the system delivery and payment reform principles included in the Affordable Care Act (ACA). We also support hospitals, physicians, academic medical centers, payers, professional associations, and other health care organizations implement the changes that impact health care providers, plans, and patients.

Experts

Topic-related Services

Health care reform models must comply with a myriad of federal and state statutes and regulations. We provide legal expertise to inform policy-making decisions and in the areas of care delivery and new payment models, to ensure that reforms comply with applicable laws.

Our policy, operational, legal, research and analytical experts provide a full spectrum of program development services. UMass consultants offer research and analysis as well as strategic and operational support. Our program development and design services enable our clients to better manage existing programs and maximize the success of new programs.

Research on current and potential models of care and evaluation of new and existing programs is essential for states and health care organizations. Our research and evaluation services allow them to make evidence-based decisions as they develop, support, and revise health care policies.

We have particular expertise in guiding states through the process of obtaining and implementing section 1115, 1915(c) and other waivers. We are well equipped to assist in developing ACA section 1332 state innovation waivers.

Related Information

There are many systems and services that contribute to children’s health, development, and well-being. However, many of our health systems are complicated, difficult to use, and have strict eligibility requirements; and many health services exist in silos and are not well coordinated. As a result, access for families is difficult. Many children who are not given a chance to thrive and get a healthy start in life grow up to be unhealthy adults with chronic and costly health conditions.

This poster describes a study of a state Medicaid population, examining heart failure-related hospitalizations and emergency department(ED) visits to the treatment cost of managing heart failure pre- and post-sacubitril/valsartan initiation. Previous studies showed that patients who were treated with sacubitril/valsartan had lower rates of hospitalizations and costs. However, studies of the economic impact of sacubitril/valsartan for the Medicaid population is limited.

The evidence is clear: When children and families receive adequate health care services, the whole of society benefits. But achieving long-term population health equity won’t be simple. It will require the transformation of pediatric primary care, and the support and participation of all payers and regulators. This policy brief, co-authored by Robert Seifert, MPA, and Hilary Deignan, JD, MEd, describes how redesigning pediatric primary care will deliver benefits to children, families, and our communities at-large.

We provide services to health and human service agencies, hospital systems and other health care organizations, and work with clients to implement a variety of health-related programs and initiatives that improve health care quality and reduce costs.